Victoria Lynn Wallace

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

79 Bonnymede Rd
Apt 104
Pueblo, CO 81001-8100

Phone

(720) 985-4453

NPI assigned

Sep 19, 2017

Last updated

Sep 19, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505779200000",
    "number": "1952820292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 BONNYMEDE RD APT 104",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011313",
            "telephone_number": "720-985-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 BONNYMEDE RD",
            "address_2": "APT 104",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810018100",
            "telephone_number": "720-985-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "VICTORIA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-19",
        "last_updated": "2017-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol G. Walker, CMT
• Cheryl Ann Walker, DO
• Rosalyn Walker, FNP-C
• Brianna Wallace
• Dedra Wallace
• Holly Anna Waller, APN
• Jordan Waller
• Nancy Waller, PA
• Spencer Waller, FNP
• Larry D Walls, MD

• Addiction (Substance Use Disorder) Counselor in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.